- Clinicopathological Analysis of Growth Patterns of Malignant Intraductal Papillary Mucinous Tumors of the Pancreas: Unusual Growth Pattern of Fistulous Extension.
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Kee Taek Jang, Ghee Young Kwon, Geunghwan Ahn
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Korean J Pathol. 2007;41(1):38-43.
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 Abstract
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- BACKGROUND
Usually, a malignant intraductal papillary mucinous tumor (IPMT) of the pancreas shows invasive carcinoma. Recently, IPMT with an unusual growth pattern of a fistulous extension was reported. However, little is known about malignant IPMTs with a different growth pattern of invasion and fistulous extension.
METHODS
Malignant IPMTs were classified into invasive (colloid or tubular type) carcinomas and the fistulous extension type according to their growth patterns. Their clinicopathological characteristics were compared.
RESULTS
Among a total of 68 cases of IPMT, there were 16 cases with malignant IPMT; eight, six and two of the colloid, tubular, and fistulous extension types, respectively. The immunohistochemical (IHC) expression of MUC1 was found in seven out of eight colloid and five out of six tubular types, but there was no IHC expression of MUC1 in the fistulous extension type. The IHC expression of MUC2 was noted in one of the eight colloid, one of the six tubular and in both cases with the fistulous extension type.
There was no difference in the tumor recurrence rates bet- ween the different growth patterns.
CONCLUSIONS
IPMT with the fistulous extension type has a peculiar extension pattern consisting of multiple fistulous tracts without a mass. Although most of the epithelium in the fistulous tract show moderate to severe dysplasia, only the fistulous extension should be considered to be an unusual growth pattern of malignant IPMT. The clinical significance of this unusual type of IPMT remains to be determined.
- Ovarian Borderline Epithelial Tumors.
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Geunghwan Ahn
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Korean J Pathol. 2005;39(5):291-300.
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- Ovarian borderline epithelial tumors are abnormal proliferative epithelial lesions without obvious invasion of the stroma of the ovary, a finding distinguishing between borderline tumors and carcinoma. There have been controversies regarding the terminology and diagnostic feature of the tumors, even though these tumors have been accepted as a distinct entity in WHO classification of ovarian epithelial tumors. This review is limited to serous and mucinous borderline tumors which are the most common and about which many clinicopathological studies have been undertaken. It has been agreed that "micropapillary carcinoma" espoused by a group of pathologists is a micropapillary variant of serous borderline tumor in the borderline ovarian tumor workshop. Diagnostic criteria of invasive implants needs further study but invasion of underlying normal tissue was reported to be correlated well with prognosis. Other issues such as diagnostic criteria of microinvasion and multiplicity of serous borderline tumors have been presented. The sole diagnostic criteria agreed upon for the diagnosis of intraepithelial carcinoma in the mucinous borderline tumor was the presence of severe cytological atypia. It was also agreed that the ovarian tumors associated with pseudomyxoma peritonei are almost invariably from gastrointestinal tract, usually appendix.
Stratification and complex intracystic growth without severe cytological atypia are considered to be characteristics of mucinous borderline tumors. Diagnostic criteria of microinvasion and two types of invasion, expansile and infiltrative invasion, have also been discussed.
- Myxoma of the Ovary with Uncertain Malignant Potential: A Case Report.
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Min A Kim, Ji Hoon Kim, Jae Y Ro, Geunghwan Ahn, In Ae Park
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Korean J Pathol. 2004;38(6):434-437.
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- Primary ovarian myxoid tumor such as myxoma, myxoid liposarcoma and myxoid leiomyosarcoma is extremely rare neoplasm. We experienced a case of unusual myxoid tumor of the ovary in a 25 year-old woman. She was admitted for an incidentally found ovarian mass during antenatal check.
Radiologic studies revealed a 5.5x5 cm-sized solid mass in left ovary and she was undertaken left oophorectomy.
Grossly, the round ovarian mass was measuring 8x6x5 cm, and the cut surface was predominantly solid with myxoid appearance. Microscopically, the tumor was surrounded by thick collagenous capsule and had moderate cellularity and rich vascularity. The tumor cells were stellate-shaped with abundant extracellular myxoid material without atypia. We initially thought this lesion as myxoma, but the cellularity was too high as an ordinary myxoma. Myxoid liposarcoma could also be considered as the differential diagnosis, however there was no convincing lipoblast. So, we diagnosed that tumor as myxoma with uncertain malignant potential.
- Osteofibrous Dysplasia-Like Adamantinoma: A Case Report with its Immunohistochemical and Ultrastructural Studies.
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Na Rae Kim, Geunghwan Ahn, Geun Woo Kim, Hyun Yee Cho, Young Ha Oh, Dong Hae Chung
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Korean J Pathol. 2004;38(1):50-55.
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- Osteofibrous dysplasia (OFD)-like adamantinoma is a rare skeletal tumor that is characterized by the predominant OFD-like pattern with scattered epithelial nests.
Adamantinoma shares clinical features (the majority of lesions in the tibia and the prevalent age group), radiologic findings (radiolucency with sclerotic shadow), and pathologic similarities (particularly the presence of scattered cytokeratin-positive stromal cells) with OFD. We describe a case of OFD-like adamantinoma. Epithelial cell nests express the epithelial membrane antigen, pancytokeratin, CK14, and collagen type IV.
Ultrastructurally, the oval to spindle cells in the epithelial foci had abundant tonofilaments, and well-formed desmosomes with dense plaques, of which well preserved desmosomes are demonstrated for the first time in OFD-like adamantinoma. These immunohistochemical and ultrastructural findings further support that the origin of epithelial cells of classic and OFD-like adamantinoma are epithelial cells transformed from fibroblastic cells in the proliferating osteofibrous tissue.
- Small Cell Carcinoma of the Uterine Cervix.
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Jinwon Seo, Jong Sun Choi, Geunghwan Ahn
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Korean J Pathol. 2003;37(6):373-378.
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Abstract
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- BACKGROUND
Small cell carcinoma of the uterine cervix is a rare and aggressive neoplasm, for which there have been few diagnostic markers.
METHODS
Eleven cases of small cell carcinoma of the uterine cervix were retrieved from pathology files.
Immunohistochemical stains were performed for two epithelial markers (cytokeratin [AE1/AE3] and epithelial membrane antigen [EMA]) and four neuroendocrine markers (neuron-specific enolase [NSE], CD56, chromogranin, and synaptophysin).
RESULTS
Of the nine cases followed up, two with initial distant metastasis died within one year. All seven remaining cases were diagnosed at stage Ib, and showed no evidence of recurrence. Nine cases were positive for one or more epithelial markers. Two cases showed positivity for epithelial markers in less than 10% of their tumor cells.
The immunoreactivity for neuroendocrine markers showed variable results; four cases were reactive for chromogranin, four were positive for synaptophysin, and seven were reactive for CD56. All cases were positive for NSE.
CONCLUSIONS
A diagnostic panel of chromogranin, synaptophysin, and CD56 rather than a single marker would be useful for the diagnosis of small-cell carcinoma of the uterine cervix.
- Atypical (Bizarre) Leiomyoma of the Prostate: A Case Report.
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Sung Rim Kim, Sang Yong Song, Geunghwan Ahn, Han Yong Choi
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Korean J Pathol. 2001;35(2):172-175.
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- Atypical (bizarre) leiomyoma of the prostate is a very rare neoplasm. Five cases have been reported in English medical literature. A 60-year-old Korean man with a history of prostatism and slightly elevated serum prostate specific antigen was presented. Microscopically, the transurethral resection specimen consisted of a proliferation of hypercellular spindle cells with intersecting bundles. The nuclei of the tumor cells showed marked pleomorphism and hyperchromasia with occasional multinucleated giant cells.
Mitoses were seen in areas of up to 2 per 10 high power fields, but there was no evidence of atypical ones. The tumor cells were immunoreactive against anti-smooth muscle actin and desmin antibodies. The proliferative index (10.0%) of the atypical leiomyoma lay between that of a benign smooth muscle and that of a leiomyosarcoma of the prostate.
Flow cytometry showed a diploid pattern with an elevated S phase fraction. To the best of our knowledge, this is the first demonstration of atypical leiomyoma of the prostate in a Korean man.
- Quality Assurance of Frozen Section Diagnosis An analysis of 5,273 consecutive cases .
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Sang Yong Song, Geunghwan Ahn
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Korean J Pathol. 1999;33(12):1182-1190.
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- Quality assurance analysis of frozen section diagnosis is very important for the pathologists to improve the diagnostic ability and the quality of medical service. We analysed 5,273 consecutive cases of frozen section diagnosis which were done in Samsung Medical Center during 10 months from June 1, 1998 to March 31. 1999 with special reference to the discordance between frozen section diagnosis and final diagnosis.
The concordance rate was 97.65%, discordance rate 1.34%, and deferred diagnosis (type 1) rate 1.01%. Category A (discordant diagnosis without any effect on the patients) was 53 cases (1.01%), category B (discordant diagnosis with minimal but no serious effect on the patients) was 10 cases (0.19%), and category C (discordant diagnosis with serious effect on the patients) was 8 cases (0.15%). Type 2 (discordant diagnosis by extra-pathologist problem) was 22 cases (0.42%) and type 3 (discordant diagnosis by pathologist problem) was 49 cases (0.93%). The most frequent causes of type 2 and 3 discordant diagnosis were presence of new lesions on deeper sections and the misinterpretation of lesions. Discordant diagnosis was noted in lymphoreticular system, central nervous system, thyroid, gastric resection margin, breast, female genital organs, intestine, hepatobiliary system, upper aerodigestive tract, urinary tract, lung, and soft tissue in descending order of frequency. Frozen section diagnosis was deferred in central nervous system, lymphoreticular system, gastric resection margin, female genital organs, thyroid, intestine, upper aerodigestive tract, lung, and soft tissue in descending order of frequency. The most important cause of discordant diagnosis was a misinterpretation of the lesions. Based on our results, a continuous and careful follow-up of quality assurance analysis of frozen section diagnosis and a share of experience of problematic cases are mandatory for the pathologists to improve the quality of medical services.
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